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Naldemedine is associated with earlier defecation in critically ill patients with opioid-induced constipation: A retrospective, single-center cohort study

by Seiya Nishiyama, Shigehiko Uchino, Yusuke Sasabuchi, Tomoyuki Masuyama, Alan Kawarai Lefor, Masamitsu Sanui

Introduction

There are few reports describing the association of naldemedine with defecation in critically ill patients with opioid-induced constipation. The purpose of this study was to determine whether naldemedine is associated with earlier defecation in critically ill patients with opioid-induced constipation.

Methods

In this retrospective cohort study, patients admitted to the Intensive Care Unit (ICU) without defecation for 48 hours while receiving opioids were eligible for enrollment. The primary endpoint was the time of the first defecation within 96 hours after inclusion. Secondary endpoints included presence of diarrhea, duration of mechanical ventilation, ICU length of stay, ICU mortality, and in-hospital mortality. The Cox proportional hazard regression analysis with time-dependent covariates was used to evaluate the association naldemedine with earlier defecation.

Results

A total of 875 patients were enrolled and were divided into 63 patients treated with naldemedine and 812 patients not treated. Defecation was observed in 58.7% of the naldemedine group and 48.8% of the no-naldemedine group during the study (p = 0.150). The naldemedine group had statistically significantly prolonged duration of mechanical ventilation (8.7 days vs 5.5 days, p Conclusion

The present study shows that naldemedine is associated with earlier defecation in critically ill patients with opioid-induced constipation.

Association between administration or recommendation of the human papillomavirus vaccine and primary care physicians knowledge about vaccination during proactive recommendation suspension: a nationwide cross-sectional study in Japan

Por: Sakanishi · Y. · Takeuchi · J. · Suganaga · R. · Nakayama · K. · Nishioka · Y. · Chiba · H. · Kishi · T. · Machino · A. · Mastumura · M. · Okada · T. · Suzuki · T.
Objective

The Japanese government suspended the proactive recommendation of the human papillomavirus vaccine (HPVv) in 2013, and the vaccination rate of HPVv declined to

Design

Cross-sectional study analysed data obtained through a web-based, self-administered questionnaire survey.

Setting

The questionnaire was distributed to Japan Primary Care Association (JPCA) members.

Participants

JPCA members who were physicians and on the official JPCA mailing list (n=5395) were included.

Primary and secondary outcome measures

The primary and secondary outcomes were the administration and recommendation of HPVv, respectively, by PCPs. The association between PCPs’ knowledge regarding vaccination and each outcome was determined based on their background and vaccination quiz scores and a logistic regression analysis to estimate the adjusted ORs (AORs).

Results

We received responses from 1084 PCPs and included 981 of them in the analysis. PCPs with a higher score on the vaccination quiz were significantly more likely to administer the HPVv for routine and voluntary vaccination (AOR 2.28, 95% CI 1.58 to 3.28; AOR 2.71, 95% CI 1.81 to 4.04, respectively) and recommend the HPVv for routine and voluntary vaccination than PCPs with a lower score (AOR 2.17, 95% CI 1.62 to 2.92; AOR 1.88, 95% CI 1.32 to 2.67, respectively).

Conclusions

These results suggest that providing accurate knowledge regarding vaccination to PCPs may improve their administration and recommendation of HPVv, even in the absence of active government recommendations.

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